title: Carotid artery stenting outcomes: do they correlate with antiplatelet response assays?
abstract: OBJECTIVE
  Limited data exist regarding the use of antiplatelet response assays during neuroendovascular intervention. We report outcomes after carotid artery stenting (CAS) based on aspirin and P2Y12 assays.
  
  
  METHODS
  We retrospectively identified patients who had aspirin and P2Y12 assays at the time of stenting. Aspirin (325 mg) and clopidogrel (75 mg) were started 7-10 days pre-intervention. If not possible, aspirin (650 mg) and clopidogrel (600 mg) loading doses were given pre-intervention. Assays were checked on postoperative day 0/1. Outcomes included neurological ischemic sequela at 30 days, 1 and 2 years, as well as 30 day death/hemorrhage/myocardial infarction.
  
  
  RESULTS
  449 patients were included. Mean P2Y12 reaction unit (PRU) values were higher in patients with an ipsilateral ischemic event (stroke/transient ischemic attack (TIA)) or stroke (alone) at 1 and 2 years than in patients with no events: ischemic event versus no event at 1 year, 252 vs 202 (p=0.008); stroke versus no stroke at 1 year, 252 versus 203(p=0.029); ischemic event versus no event at 2 years, 244 vs 203 (p=0.047); stroke versus no stroke at 2 years, 243 versus 203 (p=0.082). Ischemic event free survival (stroke/TIA, p=0.0268) and overall survival (p=0.0291) post-CAS were longer in patients with PRU ≤198 compared with an initial threshold of PRU ≤237. Mean PRU values were higher in patients who died from all causes at 30 days than in survivors (p=0.031). No correlation was found between lower PRU values and hemorrhage. Aspirin reaction units did not correlate with outcome.
  
  
  CONCLUSIONS
  PRU ≤198 may be associated with a lower incidence of ischemic neurological sequela and death post-CAS. Prospective studies are needed to validate the relationship between antiplatelet assays and outcomes post-CAS.
authors.affiliation: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors.forename: Grant C
authors.initials: GC
authors.lastname: Sorkin
authors.forename: Travis M
authors.initials: TM
authors.lastname: Dumont
authors.forename: Michael M
authors.initials: MM
authors.lastname: Wach
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Eller
authors.forename: Maxim
authors.initials: M
authors.lastname: Mokin
authors.forename: Sabareesh K
authors.initials: SK
authors.lastname: Natarajan
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Baxter
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage*; D002545:Brain Ischemia / Q000401:mortality / Q000517:prevention & control; D016893:Carotid Stenosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D000077144:Clopidogrel; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D015995:Prevalence; D058925:Receptors, Purinergic P2Y12 / Q000378:metabolism; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D058925:Receptors, Purinergic P2Y12; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Drug; Platelets; Stent; Stroke; Technique